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Dyslipidemia

Prof. Dr. Djoni Djunaedi, dr., Sp.PD., KPTI


Dosen FK – UMM, ©2012
Adapted from SUMETSU Update 2 (2006); Harrison’s 17th Ed.
(2008); Medical Physiology, Guyton & Hall, 11th Ed. (2006);
Product Knowledge Prodia (2004), Current Medical Diagnosis &
Treatment, McPhee & Papadakis (2009)
Definisi
• Dislipidemia  kelainan metabolisme lipid
yang ditandai dengan peningkatan maupun
penurunan fraksi lipid dalam plasma.
Kelainan fraksi lipid yang utama adalah
kenaikan kadar kholesterol total, kholesterol
LDL, Trigliseride (TGL), serta penurunan
kadar kholesterol HDL.
Lipid metabolism

Several chemical compunds in food and in th body are


classified as lipid:
• Neutral fat / triglyceride (TG)
• Phospholipids
• Cholesterol
• Few others (less important)

Stearic acid (fully saturated)


TG: glycerol Oleic acid (has double bound)

Palmitic acid (fully saturated)


• Transport of TG and other lipids from GIT by lymph 
chylomicron (dispered / droplets)

• Most cholesterol dan phospholipids from GIT  enter the


chylomicron

• Free fatty acid are transported in the blood in combination


with albumin

• 95% of all lipids in the plasma in the form of lipoprotein

Mg / dl of plasma
Cholesterol 180
Phospholipids 160
Triglycerides 160
Protein 200
Types of lipoprotein:
• Very low density lipoproteins / VLDL
• Intermediate-density lipoproteins
• Low-density lipoproteins / LDL
• High-density lipoproteins / HDL
− high concentration of protein  ± 50%
− Smaller concentration of cholesterol and
phospholipids
Use of TG for energy:

Formation of ATP: β-oxydation of fatty acids to yield acetyl Co-A


Basic causes of atheroclerosis – the roles of
cholesterol and lipoprotein

• Increased LDL

• Form hypercholesterolism

• HDL in preventing atherosclerosis  absorb cholesterol crystal


Other major risk factors for atherosclerosis:

Predispose factors:
• Physical activity / obesity
• Diabetes mellitus
• Hypertention
• Hiperlipidemia
• Cigarette smoking
• Special type of LDL called Lp(a) containing additional proteins:
apoprotein (a)
II. Fat metabolism
Although most cells of the body metabolize fat, certain aspect of fat metabolism
occur mainly in the liver

1. Oxidation of fatty acid to supply energy for other body function


2. Synthesis of large quantities of cholesterol, phospholipids and
most lipoproteins
3. Synthesis of fat from protein and carbohydrate
Energy derived from neutral fasts:
• Fat __. Glycerol + fatty acids
• Fatty acids are split by beta-oxidation into 2-carbon acetyl radicals that
form acetyl coenzyme A (acetyl –CoA)
• 2 mol acetyl-CoA  acetoacetic acid transported throughtout the
body to be absobed by other tissue  reconvert the acetyl-CoA 
oxidize  energy
• ± 80% cholesterol  bile salt  secreted into the bile, the reminder is
transported in the lipoproteins  carried by the blood  tissue cells
everywhere in the body
• Phospholipids synthesized in the liver  transported principally in the
lipoproteins
• After fat is synthesized in the liver  it is transported in the lipoproteins
to the adipose tissue to be stored
Klasifikasi Dislipidemia menurut EAS
(European Atherosclerosis Society)
Klasifikasi Dislipidemia menurut WHO
About Cholesterol
Peran Kholesterol
• Manfaat Kholesterol:
– Sumber energi
– Pembentukan dinding sel
– Pembentukan hormon
• Sumber Kholesterol:
– Sintesis tubuh
– Dari makanan
• Bahaya kholesterol berlebih:
– Memicu proses aterosklerosis
Cholesterol molecule structure
Cholesterol synthesis
Kriteria diagnostik kholesterol
Kholesterol LDL   
BERBAHAYA karena merupakan cikal bakal
terjadinya proses Aterosklerosis
LDL – teroksidasi 1
paling berbahaya
LDL – densitas kecil 2
lebih berbahaya
LDL – kholesterol 3
berbahaya
Kholesterol HDL 
Bahaya karena:
• Berperan dalam transpor balik kholesten:
– Menghambat tumbuhnya plak baru
– Meningkatkan stabilitas plak
• Berperan sebagai antioksidan:
– Menghambat oksidasi LDL
Sources of cholesterol
Triglycerides (TGL)
TGL molecule structure
Use of TGL for energy:
Formation of ATP: β-oxydation of fatty
acids to yield acetyl Co-A
TGL molecule
Mekanisme Pembentukkan Small Dense
LDL
The role
of TGL in
dyslipi-
demia
Phospholipid molecule structure
More on Phospolipid molecule
structure
Phospolipid bilayer
Phospolipid bilayer
Specific uses of Phospholipid
1. Important constituent of lipoproteins
2. Thromboplastin  initiate the clotting
process
3. Sphingomyelin are present in the nervous
system
4. Donors of phospate radicals
5. Participate in the formation of structural
elements –mainly membranes– in cells
Penyakit Jantung Koroner (PJK)
Lihat gambar biar lebih mantap...
The process of getting Atherosclerosis
Let’s talk about probability ...
Mengurangi risiko kena PJK
Metabolic Syndrome (The MetS)
TERIMAKASIH